General Surgery Preoperative Cardiac Evaluation of Noncardiac Surgical Patients: Review Questions Jamal J. Hoballah, MD, MBA, FACS, and Alan F. Ross, MD Dr. Hoballah is a professor of surgery, University of Iowa Roy J. and Lucille A. Carver College of Medicine, and director, Division of Vascular Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA. Dr. Ross is an associate professor of anesthesia, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City. Choose the single best answer for each question.
	1. A 72-year-old man presents to the emergency department with sudden onset of abdominal pain with fever and tenderness. A chest radiograph reveals free air under the diaphragm. His past medical history is significant for episodes of diverticulitis. He is known to have severe coronary artery disease and a history of myocardial infarction (MI) 2 years prior to admission. What is the next step in this patient’s management? Adenosine thallium scan Cardiac catheterization Dobutamine stress echocardiogram Exploratory laparotomy with intensive monitoring Intravenous antibiotics and observation Click here to compare your answer. 2. A 59-year-old woman presents to the outpatient clinic with a thyroid nodule. She is scheduled for hemithyroidectomy. Her past medical history is significant for diabetes and chronic smoking. She had an MI 3 years prior to admission. Currently, she is taking a ß-blocker and nitrates and has occasional angina with moderate exercise. Which of the following is the next step in this patient’s management? Adenosine thallium scan Perform a cardiac catheterization Proceed with the hemithyroidectomy Order a thallium scan Order an exercise stress test Click here to compare your answer.		3. A 54-year-old man with ulcerative colitis is scheduled for total colectomy and ileoproctostomy. His past medical history is significant for chronic smoking, diabetes, and a prior MI. He leads a sedentary lifestyle and denies any history of angina. What would be the next step in this patient’s management? Cardiac catheterization Exercise stress testing Left ventricular ejection fraction determination No further evaluation Surgery under epidural anesthesia Click here to compare your answer. 4. A 65-year-old man with no previous medical problems is diagnosed with a 5.5-cm abdominal aortic aneurysm. He denies any heart symptoms. He exercises daily and jogs 2 miles twice weekly. His electrocardio- gram is normal, as are his blood urea nitrogen and serum creatinine levels. Which of the following would be the most appropriate next step in this patient’s management? Adenosine thallium scan Dobutamine stress echocardiogram Ejection fraction determination Exercise stress testing Proceed with surgery without further cardiac evaluation Click here to compare your answer. 5. Which of the following is NOT a contraindication to performing a dobutamine stress echocardiogram? Chest pain on exertion Recent MI Severe aortic stenosis Severe hypertension Unstable angina Click here to compare your answer.
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